Despite therapeutic advances in the medical treatment of HF patients, the
prognosis remains poor. Coronary revascularization in patients with ischaemic
cardiomyopathy is associated with amelioration of symptoms and survival benefit.
Percutaneous coronary intervention with stenting is associated with excellent outcome,
high procedural success rate, low event rates, and can be safely performed in patients
with ischaemic cardiomyopathy. Patients with complex coronary artery disease require
surgical revascularization (Coronary Artery Bypass Grafting - CABG). Cardiac
resynchronization therapy (CRT) aims to re-establishing synchronous contraction
between the left ventricular free wall and the interventricular septum, resulting in an
increase in stroke volume. In clinical terms, this is translated in functional class
improvement. This generally involves biventricular pacing (pacing of the left and right
ventricle through separate leads). Surgical strategy for the management of patients with
end-stage ischaemic heart disease includes “conventional” techniques (surgical
revascularization, the most common surgical procedure, surgical ventricular restoration
in patient with a dyskinetic part in the left ventricle and mitral valve surgery for mitral
regurgitation). Mechanical circulatory support aims to restore blood flow and pressure,
and thus end-organ function, in patients with profound cardiogenic shock or in endstage
patients (stage D) with advanced NYHA III-IV symptoms as a bridge to
transplantation or as lifelong support (destination therapy). Heart transplantation is
associated with excellent long-term results in terms of symptomatic relief and
prognostic benefit under strict criteria involving the recipient and the donor. In the face
of evolving technology, lifetime mechanical support provides a realistic alternative to
heart transplantation.
Keywords: Cardiac resynchronization therapy, Coronary artery bypass grafting, Coronary heart disease, Extracorporeal life support, Heart transplantation, Implantable
cardioverter defibrillator, Ischeamic heart failure, Left ventricular assist device,
Mechanical circulatory support, Percutaneous coronary intervention, Surgical ventricular
restoration.
